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MI Internal Medicine and Infectious Disease > URTI's > Flashcards

URTI's Flashcards

1
Q

What is the most significant method for transmission of the common cold?

A

Hands (droplet is less significant)

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2
Q

Describe the infectivity of the common cold

A

Viral shedding peaks on 3rd day, coinciding with peak symptoms. Low level shedding continues for 2 weeks.

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3
Q

What is the incubation period of the common cold?

A

24-72 hours

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4
Q

Name some viruses that cause the common cold

A

Rhinovirus, RSV, influenza, parainfluenza, adenovirus, enterovirus, coronavirus, human metapneumovirus

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5
Q

Briefly outline the pathogenesis of the common cold

A
  1. Virus deposited on nasal/conjunctival mucosa - attaches via host cell receptors
  2. Viral replication - host defence activated as cells are damaged
  3. Cytokine release (IL-8) attracts PMNs
  4. Increase in nasal secretions and slowed mucociliary clearance
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6
Q

Severity of symptoms of the common cold correlate with what?

A

IL-8 level

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7
Q

Rhinovirus infection results in the release of albumin and bradykinins, what is the outcome of this?

A
  1. Increased vascular permeability in nasal lamina propria

2. Bradykinins cause rhinitis, sore throat

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8
Q

What are the symptoms of the common cold in an infant?

A

Fever and and nasal discharge

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9
Q

What is the duration of the common cold?

A

10 days. Prolonged in smokers. Can last 2-3 weeks

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10
Q

What should be on your differential Dx (DDx) if you suspect the common cold?

A
  1. Allergic rhinitis
  2. Acute bacterial sinusitis
  3. Nasal foreign body
  4. Pertussis
  5. Structural abnormalities of the nose/sinuses
  6. Influenza
  7. Bacterial pharyngitis
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11
Q

What are some OTC recommendations for the common cold?

A
  1. Antipyretic/pain control
  2. Saline irrigation
  3. Steam inhalation
  4. Decongestants
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12
Q

The majority of the cases of pharyngitis are due to what?

A

Viruses

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13
Q

20-30% of sore throats in children and 5-15% in adults are attributed to this…

A

GAS (S. pyogenes)

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14
Q

Pharyngitis is unusual in children under the age of 3, T of F?

A

True, it is most common in school aged children.

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15
Q

What is the incubation period for GAS pharyngitis?

A

2-5 days

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16
Q

What is the infectivity of GAS pharyngitis?

A
  1. Highly communicable

2. Usually non-infectious within 24 hrs of antibiotic therapy

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17
Q

How is GAS pharyngitis spread?

A
  1. Person to person

2. Respiratory droplet

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18
Q

Viral pharyngitis is caused only by respiratory viruses, T or F?

A

False. Non-respiratory viruses may also be responsible.

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19
Q

Describe some of the virulence factors that S. pyogenes has.

A
  1. Capsule - hyaluronic acid (camouflage)
  2. M proteins - resist phagocytosis
  3. Invasins and exotoxins (hemolysins) - cause tissue damage
  4. Streptolysin O - cytotoxin (including myocardium)
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20
Q

If GAS pharyngitis is left untreated or is treated inappropriately, what risk does this pose?

A

3% risk of Rheumatic fever

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21
Q

What collection of clinical features may indicate a viral etiology for pharyngitis? (6)

A
  1. Conjunctivitis
  2. Cough
  3. Hoarseness
  4. Rhinorrhea
  5. Diarrhea
  6. Rash
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22
Q

What are the typical S/S of GAS pharyngitis? (4)

A
  1. Pharyngeal or tonsillar exudate
  2. Fever
  3. Tender/enlarged anterior cervical lymph nodes
  4. Absence of cough
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23
Q

When should you not test someone who presents with pharyngitis?

A

If the the S/S suggest a viral cause

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24
Q

What testing is available if you suspect bacterial pharyngitis?

A
  1. Throat culture

2. Rapid antigen detection test (RADT)

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25
Q

How should you manage viral pharyngitis?

A
  1. Symptomatic therapy: analgesic/antipyretic

2. NO ANTIBIOTICS

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26
Q

What is the Tx for GAS pharyngitis?

A
  1. Penicillin x 10 days

2. OR Clindamycin

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27
Q

List some benefits of antibiotic Tx for GAS pharyngitis

A
  1. Prevents complications (i.e. peritonsillar abscess, cervical lymphadenitis, rheumatic fever)
  2. Decreases transmission
  3. MINIMAL symptom improvement
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28
Q

In what age group is acute otitis media most prevalent?

A

Infants

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29
Q

List some risks factors for acute otitis media

A

Age (6-18 months), family Hx, daycare, lack of breastfeeding, tobacco smoke or air pollution, pacifier use, First Nations, poverty, lack of access to care

30
Q

What is the etiology of acute otitis media in 2/3 of patients?

A

Viral and bacterial combination

31
Q

What 2 factors are essential in the patho. of AOM?

A
  1. Antecedent viral URTI

2. Colonization with a respiratory bacterial infection

32
Q

Briefly describe the patho. of AOM

A
  1. Inflammation in response to virus obstructs isthmus of Eustachian tube
  2. Obstruction causes -ve pressure leading to the build up of secretions
  3. Bacteria colonizing the URT enter the middle ear and growth in the secretions
33
Q

S/S’s of AOM in children can include: (4)

A
  1. Otalgia
  2. Bulging of the tympanic membrane
  3. Otorrhea
  4. Hearing loss
34
Q

List 5 complications of AOM

A
  1. Vertigo
  2. Tinnitus
  3. Facial paralysis
  4. Mastoiditis
  5. Meningitis
35
Q

What is included in the Tx of AOM

A
  1. Watchful waiting
  2. Pain relief
  3. Amoxicillin (best coverage for S. pneumoniae)
36
Q

Why is a 3 month follow up recommended for AOM?

A

To assess for the presence of fluid in the ear, which can lead to hearing loss if not corrected.

37
Q

What is the spontaneous resolution rate of acute sinusitis?

A

About 70%

38
Q

What the most common cause of acute sinusitis?

A

Viral is 200X more common than bacterial

39
Q

3 viral agents that can cause acute sinusitis

A
  1. Rhinovirus
  2. Influenza
  3. Parainfluenza
40
Q

What is the natural progression of acute viral sinusitis?

A

Typically resolves in 7-10 days

41
Q

List some bacteria that may cause acute sinusitis

A
  1. S. pneumoniae
  2. H. influenzae
  3. M. catarrhalis
  4. Anaerobes (associated with dental disease)
42
Q

Briefly outline the patho. of acute sinusitis

A
  1. Common cold –> viral rhinitis –> spreads to paranasal sinuses
  2. Inflammation of sinuses = impairment of mucociliary defences, and 2ndary spread of bacteria into nasal cavities
43
Q

What conditions predispose someone to acute sinusitis (4)

A
  1. Dental infections
  2. Allergies
  3. Swimming
  4. Mechanical obstruction of nose
44
Q 
What imaging is recommended for acute sinusitis:
A - X-ray
B - CT
C - MRI
D - None of the above
A

D - imaging is not recommended

45
Q

How do you Dx acute sinusitis?

A
  1. Based on Hx and physical exam (purulent rhinorrhea, nasal congestion)
46
Q

To Dx bacterial sinusitis…

A
  1. URTI symptoms for > 10 days or worse after 5-7

AND, nasal congestion/purulent nasal discharge + facial pain - with or w/o fever/maxillary tooth ache/facial swelling

47
Q

How do you manage acute sinusitis?

A
  1. Analgesics
  2. Steam inhalation
  3. Decongestants
  4. NO ANTIHISTAMINES
  5. Selective antibiotic therapy = amoxicillin
48
Q

Croup is AKA…

A

Laryngotracheitis

49
Q

What is Croup?

A

Self-limited illness characterized by inflammation of larynx and trachea

50
Q

Croup is most common for what age group?

A
  1. 6-36 months

2. Rare beyond 6 yrs of age

51
Q

What time of day is Croup most common?

A
  1. Late evening or early morning

2. Recurrences are common

52
Q

What is the most common cause of Croup?

A

Parainfluenza virus type 1

53
Q

Briefly describe the patho. of Croup?

A
  1. Virus infects nasal pharyngeal mucosa
  2. It invades respiratory epithelium and causes inflammation of cartilage in subglottic region
  3. This narrows the trachea
  4. Fibrinous exudates may worsen narrowing
54
Q

What may predispose someone to Croup? (3)

A
  1. Genetics (differing immune response to Parainfluenza virus)
  2. Anatomic narrowing
  3. Hyperactive airways
55
Q

What is the typical presentation of Croup?

A
  1. Sudden onset (inspiratory stridor, cough, hoarseness)
  2. Rapidly progressive
  3. Previous Hx of Croup
56
Q

What is the hallmark of Croup in infants?

A

Barking cough

57
Q

What is the DDx for Croup?

A
  1. Epiglottitis (throat pn more prominent, difficulty swallowing, LOTS OF SALIVA, high fever)
  2. Pharyngitis
  3. Foreign body aspiration
  4. Allergic reaction (swelling of lips/tongue, rash)
  5. Peritonsillar abscess (enlarged lymph nodes, tonsillar asymmetry
58
Q

Outline the management of Croup

A
  1. NO ANTIBIOTICS (viral)
  2. Systemic/nebulized steroids

If severe:

  • Nebulized epi
  • Blow-by O2 if hypoxic
  • NO SEDATION
59
Q 
Whooping cough is:
A - a boy band
B - not a big deal
C - highly contagious RT infection
D - none of the above
A

C

60
Q 
Pertussis occurs in cyclic epidemics every:
A - 3 years
B - year
C - decade
D - 2-5 years
A

D

61
Q

How is Pertussis transmitted?

A
  1. Direct contact

2. Inhalation of respiratory droplets

62
Q

What is the incubation period of Pertussis?

A

7-10 days (4-21 days)

63
Q

What causes Whooping Cough?

A

Bordetella pertussis

64
Q

Features of B. pertussis (3)

A
  1. Obligate human pathogen
  2. Fastidious Gram -ve coccobacilli
  3. Needs special growth medium
65
Q

List some virulence factors of B. pertussis

A
  1. Adhesins
  2. Tracheal cytotoxin/dermonecrotic toxin
  3. Interferes with host immune system
  4. Endotoxins
66
Q

Classic clinical manifestations of Pertussis (3)

A
  1. Paroxysmal cough
  2. Inspiratory whoop
  3. Post-tussive emesis
67
Q

In which age group is Pertussis most deadly?

A

Infants

68
Q

What labs can be performed if you suspect Pertussis?

A
  1. cough < 3 weeks = nasopharyngeal swab for culture and PCR

2. cough > 3 weeks = PCR

69
Q

What is the antibiotic therapy for Pertussis?

A
  1. Macrolide or TMP-SMX
70
Q

What are the potential benefits of antibiotic therapy for Pertussis?

A
  1. May reduce duration and severity of cough

2. Limits transmission

71
Q

When would you give prolonged antibiotic therapy for Pertussis?

A
  1. If there is potential for exposure to high risk pt’s (i.e. infants, pregnant women, healthcare worker, childcare worker)
72
Q

What were the 6 URTI’s presented in lecture?

A
  1. Common Cold
  2. Pharyngitis
  3. Otitis media
  4. Sinusitis
  5. Croup
  6. Pertussis

MI Internal Medicine and Infectious Disease (35 decks)

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